Lung Cancer and Cardiovascular Disease Mortality Associated with Ambient Air Pollution and Cigarette Smoke: Shape of the Exposure–Response Relationships

TLDR

Lung cancer and cardiovascular disease mortality rise with smoking, secondhand smoke, and fine particulate matter (PM₂.₅) exposure, and recent studies show the CVD exposure–response curve is nonlinear, steep at low exposures and flattening at higher levels. The study aimed to generate comparable exposure–response estimates for lung cancer and cardiovascular mortality from PM₂.₅ to inform disease burden calculations and public health policy, using prospective cohort data from 1.2 million adults in the Cancer Prevention Study II. Relative risks were estimated for cigarette smoking increments, adjusted for individual risk factors, and plotted against daily PM₂.₅ doses from smoking, ambient air pollution, and secondhand smoke. CVD mortality risks rise steeply at low PM₂.₅ exposures and plateau at higher levels (RR ≈ 2–3 for smoking), whereas lung cancer risks increase nearly linearly, leading to a shift where cardiovascular deaths dominate the burden at low exposures but lung cancer becomes proportionally more important at high PM₂.₅ levels.

Abstract

Lung cancer and cardiovascular disease (CVD) mortality risks increase with smoking, secondhand smoke (SHS), and exposure to fine particulate matter < 2.5 μm in diameter (PM₂.₅) from ambient air pollution. Recent research indicates that the exposure-response relationship for CVD is nonlinear, with a steep increase in risk at low exposures and flattening out at higher exposures. Comparable estimates of the exposure-response relationship for lung cancer are required for disease burden estimates and related public health policy assessments.We compared exposure-response relationships of PM₂.₅ with lung cancer and cardiovascular mortality and considered the implications of the observed differences for efforts to estimate the disease burden of PM2.5.Prospective cohort data for 1.2 million adults were collected by the American Cancer Society as part of the Cancer Prevention Study II. We estimated relative risks (RRs) for increments of cigarette smoking, adjusting for various individual risk factors. RRs were plotted against estimated daily dose of PM₂.₅ from smoking along with comparison estimates for ambient air pollution and SHS.For lung cancer mortality, excess risk rose nearly linearly, reaching maximum RRs > 40 among long-term heavy smokers. Excess risks for CVD mortality increased steeply at low exposure levels and leveled off at higher exposures, reaching RRs of approximately 2-3 for cigarette smoking.The exposure-response relationship associated with PM₂.₅ is qualitatively different for lung cancer versus cardiovascular mortality. At low exposure levels, cardiovascular deaths are projected to account for most of the burden of disease, whereas at high levels of PM₂.₅, lung cancer becomes proportionately more important.